Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

SPECTAZOLE 1%/15GM

Facility

$66.00

Hospital Charge Code	60633917
Hospital Revenue Code	250
Min. Negotiated Rate	$1.59
Max. Negotiated Rate	$33.00
Rate for Payer: Aetna Commercial	$25.08
Rate for Payer: Aetna Medicare Advantage	$19.80
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.83
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.83
Rate for Payer: Cigna Commercial	$33.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$19.80
Rate for Payer: Oxford Commercial	$13.20
Rate for Payer: Qualcare PPO/HMO/WC	$9.90
Rate for Payer: UnitedHealthcare Commercial	$13.20
Rate for Payer: UnitedHealthcare Community & State	$1.59
Rate for Payer: Wellpoint Medicaid Managed Care	$1.75

SPECTINOMYCIN INJ IM 2GM

Facility

$221.25

Hospital Charge Code	60627327
Hospital Revenue Code	636
Min. Negotiated Rate	$33.19
Max. Negotiated Rate	$53.54
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.54
Rate for Payer: Qualcare PPO/HMO/WC	$33.19

SPECTINOMYCIN INJ IM 2GM

Facility

$221.25

Hospital Charge Code	60627327
Hospital Revenue Code	636
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$110.62
Rate for Payer: Aetna Commercial	$84.08
Rate for Payer: Aetna Medicare Advantage	$66.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$56.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$56.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$56.42
Rate for Payer: Cigna Commercial	$110.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$53.54
Rate for Payer: Qualcare PPO/HMO/WC	$33.19
Rate for Payer: UnitedHealthcare Community & State	$5.33
Rate for Payer: Wellpoint Medicaid Managed Care	$5.86

SPECTRAPENILEPROSTHES9.5X16CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270663878
Hospital Revenue Code	278
Min. Negotiated Rate	$791.32
Max. Negotiated Rate	$16,417.50
Rate for Payer: Aetna Commercial	$12,477.30
Rate for Payer: Aetna Medicare Advantage	$9,850.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,372.92
Rate for Payer: Cigna Commercial	$16,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,223.70
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25
Rate for Payer: UnitedHealthcare Community & State	$791.32
Rate for Payer: Wellpoint Medicaid Managed Care	$870.13

SPECTRAPENILEPROSTHES9.5X16CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270663878
Hospital Revenue Code	278
Min. Negotiated Rate	$4,925.25
Max. Negotiated Rate	$7,946.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,223.70
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25

SPECTRA PENILE PROSTHESIS

Facility

$57,475.00

Service Code	HCPCS C2622
Hospital Charge Code	270685525
Hospital Revenue Code	278
Min. Negotiated Rate	$1,385.15
Max. Negotiated Rate	$28,737.50
Rate for Payer: Aetna Commercial	$21,840.50
Rate for Payer: Aetna Medicare Advantage	$17,242.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$14,656.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$14,656.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,495.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$14,656.12
Rate for Payer: Cigna Commercial	$28,737.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,908.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,644.50
Rate for Payer: Qualcare PPO/HMO/WC	$8,621.25
Rate for Payer: UnitedHealthcare Community & State	$1,385.15
Rate for Payer: Wellpoint Medicaid Managed Care	$1,523.09

SPECTRA PENILE PROSTHESIS

Facility

$57,475.00

Service Code	HCPCS C2622
Hospital Charge Code	270685525
Hospital Revenue Code	278
Min. Negotiated Rate	$8,621.25
Max. Negotiated Rate	$13,908.95
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$11,495.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$13,908.95
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$12,644.50
Rate for Payer: Qualcare PPO/HMO/WC	$8,621.25

SPECTRAPENILEPROSTHESIS12X12CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270661187
Hospital Revenue Code	278
Min. Negotiated Rate	$791.32
Max. Negotiated Rate	$16,417.50
Rate for Payer: Aetna Commercial	$12,477.30
Rate for Payer: Aetna Medicare Advantage	$9,850.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8,372.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8,372.92
Rate for Payer: Cigna Commercial	$16,417.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,223.70
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25
Rate for Payer: UnitedHealthcare Community & State	$791.32
Rate for Payer: Wellpoint Medicaid Managed Care	$870.13

SPECTRAPENILEPROSTHESIS12X12CM

Facility

$32,835.00

Service Code	HCPCS C2622
Hospital Charge Code	270661187
Hospital Revenue Code	278
Min. Negotiated Rate	$4,925.25
Max. Negotiated Rate	$7,946.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$6,567.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$7,946.07
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$7,223.70
Rate for Payer: Qualcare PPO/HMO/WC	$4,925.25

SPECTRA REAR TIP EXTENDER 9.5

Facility

$21.40

Service Code	HCPCS C1813
Hospital Charge Code	270663879
Hospital Revenue Code	278
Min. Negotiated Rate	$3.21
Max. Negotiated Rate	$5.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4.71
Rate for Payer: Qualcare PPO/HMO/WC	$3.21

SPECTRA REAR TIP EXTENDER 9.5

Facility

$21.40

Service Code	HCPCS C1813
Hospital Charge Code	270663879
Hospital Revenue Code	278
Min. Negotiated Rate	$0.52
Max. Negotiated Rate	$10.70
Rate for Payer: Aetna Commercial	$8.13
Rate for Payer: Aetna Medicare Advantage	$6.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4.28
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.46
Rate for Payer: Cigna Commercial	$10.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.18
Rate for Payer: New Jersey Carpenters Health Fund Self Funded Medical Benefit Plan	$4.71
Rate for Payer: Qualcare PPO/HMO/WC	$3.21
Rate for Payer: UnitedHealthcare Community & State	$0.52
Rate for Payer: Wellpoint Medicaid Managed Care	$0.57

SPECULA KLEENSPEC VAGINAL DISP

Facility

$484.35

Hospital Charge Code	270654035
Hospital Revenue Code	272
Min. Negotiated Rate	$11.67
Max. Negotiated Rate	$242.18
Rate for Payer: Aetna Commercial	$184.05
Rate for Payer: Aetna Medicare Advantage	$145.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$123.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$123.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$123.51
Rate for Payer: Cigna Commercial	$242.18
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$145.31
Rate for Payer: Oxford Commercial	$96.87
Rate for Payer: Qualcare PPO/HMO/WC	$72.65
Rate for Payer: UnitedHealthcare Commercial	$96.87
Rate for Payer: UnitedHealthcare Community & State	$11.67
Rate for Payer: Wellpoint Medicaid Managed Care	$12.84

SPECULA KLEENSPEC VAGINAL DISP

Facility

$484.35

Hospital Charge Code	270654035
Hospital Revenue Code	272
Min. Negotiated Rate	$72.65
Max. Negotiated Rate	$72.65
Rate for Payer: Qualcare PPO/HMO/WC	$72.65

SPECULUM VAG DISPOS W/BUILT IN

Facility

$21.27

Hospital Charge Code	270654043
Hospital Revenue Code	272
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$10.63
Rate for Payer: Aetna Commercial	$8.08
Rate for Payer: Aetna Medicare Advantage	$6.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5.42
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5.42
Rate for Payer: Cigna Commercial	$10.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.38
Rate for Payer: Oxford Commercial	$4.25
Rate for Payer: Qualcare PPO/HMO/WC	$3.19
Rate for Payer: UnitedHealthcare Commercial	$4.25
Rate for Payer: UnitedHealthcare Community & State	$0.51
Rate for Payer: Wellpoint Medicaid Managed Care	$0.56

SPECULUM VAG DISPOS W/BUILT IN

Facility

$21.27

Hospital Charge Code	270654043
Hospital Revenue Code	272
Min. Negotiated Rate	$3.19
Max. Negotiated Rate	$3.19
Rate for Payer: Qualcare PPO/HMO/WC	$3.19

SPECULUM VAGINAL DISP

Facility

$4.85

Hospital Charge Code	270301895
Hospital Revenue Code	270
Min. Negotiated Rate	$0.73
Max. Negotiated Rate	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.73

SPECULUM VAGINAL DISP

Facility

$4.85

Hospital Charge Code	270301895
Hospital Revenue Code	270
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$1.84
Rate for Payer: Aetna Medicare Advantage	$1.46
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.24
Rate for Payer: Cigna Commercial	$2.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.46
Rate for Payer: Oxford Commercial	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.73
Rate for Payer: UnitedHealthcare Commercial	$0.97
Rate for Payer: UnitedHealthcare Community & State	$0.12
Rate for Payer: Wellpoint Medicaid Managed Care	$0.13

SPECULUM VAGINAL DISP ********

Facility

$11.00

Hospital Charge Code	8003386
Hospital Revenue Code	279
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$5.50
Rate for Payer: Aetna Commercial	$4.18
Rate for Payer: Aetna Medicare Advantage	$3.30
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.81
Rate for Payer: Cigna Commercial	$5.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Oxford Commercial	$2.20
Rate for Payer: Qualcare PPO/HMO/WC	$1.65
Rate for Payer: UnitedHealthcare Commercial	$2.20
Rate for Payer: UnitedHealthcare Community & State	$0.27
Rate for Payer: Wellpoint Medicaid Managed Care	$0.29

SPECULUM VAGINAL DISP ********

Facility

$11.00

Hospital Charge Code	8003386
Hospital Revenue Code	279
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$1.65
Rate for Payer: Qualcare PPO/HMO/WC	$1.65

SPECULUM VAGINAL DISP LARGE 10

Facility

$17.25

Hospital Charge Code	2709006405
Hospital Revenue Code	272
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$8.62
Rate for Payer: Aetna Commercial	$6.55
Rate for Payer: Aetna Medicare Advantage	$5.17
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.40
Rate for Payer: Cigna Commercial	$8.62
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.17
Rate for Payer: Oxford Commercial	$3.45
Rate for Payer: Qualcare PPO/HMO/WC	$2.59
Rate for Payer: UnitedHealthcare Commercial	$3.45
Rate for Payer: UnitedHealthcare Community & State	$0.42
Rate for Payer: Wellpoint Medicaid Managed Care	$0.46

SPECULUM VAGINAL DISP LARGE 10

Facility

$17.25

Hospital Charge Code	2709006405
Hospital Revenue Code	272
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$2.59
Rate for Payer: Qualcare PPO/HMO/WC	$2.59

SPECULUM VAGINAL ER-SPEC L

Facility

$1,248.00

Hospital Charge Code	270665605
Hospital Revenue Code	270
Min. Negotiated Rate	$30.08
Max. Negotiated Rate	$624.00
Rate for Payer: Aetna Commercial	$474.24
Rate for Payer: Aetna Medicare Advantage	$374.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$318.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$318.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$318.24
Rate for Payer: Cigna Commercial	$624.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$374.40
Rate for Payer: Oxford Commercial	$249.60
Rate for Payer: Qualcare PPO/HMO/WC	$187.20
Rate for Payer: UnitedHealthcare Commercial	$249.60
Rate for Payer: UnitedHealthcare Community & State	$30.08
Rate for Payer: Wellpoint Medicaid Managed Care	$33.07

SPECULUM VAGINAL ER-SPEC L

Facility

$1,248.00

Hospital Charge Code	270665605
Hospital Revenue Code	270
Min. Negotiated Rate	$187.20
Max. Negotiated Rate	$187.20
Rate for Payer: Qualcare PPO/HMO/WC	$187.20

SPECULUM VAGINAL ER-SPEC M

Facility

$1,404.00

Hospital Charge Code	270665604
Hospital Revenue Code	270
Min. Negotiated Rate	$210.60
Max. Negotiated Rate	$210.60
Rate for Payer: Qualcare PPO/HMO/WC	$210.60

SPECULUM VAGINAL ER-SPEC M

Facility

$1,404.00

Hospital Charge Code	270665604
Hospital Revenue Code	270
Min. Negotiated Rate	$33.84
Max. Negotiated Rate	$702.00
Rate for Payer: Aetna Commercial	$533.52
Rate for Payer: Aetna Medicare Advantage	$421.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$358.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$358.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$358.02
Rate for Payer: Cigna Commercial	$702.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$421.20
Rate for Payer: Oxford Commercial	$280.80
Rate for Payer: Qualcare PPO/HMO/WC	$210.60
Rate for Payer: UnitedHealthcare Commercial	$280.80
Rate for Payer: UnitedHealthcare Community & State	$33.84
Rate for Payer: Wellpoint Medicaid Managed Care	$37.21

Know your out-of-pocket cost for care.

All Charges